Surgical treatment for aortic valve disease may involve open-heart surgery to remove or repair a damaged valve, or less invasive procedures such as balloon valvuloplasty.
Surgical treatment for aortic valve failure can provide an effective and durable outcome. However, challenges associated with TAVR, particularly in younger patients, remain unresolved.
What to Expect
Medications can often help with mild cases of heart valve disease, but severe cases of aortic stenosis can cause damage to the heart muscle and lead to heart failure and death.
When symptoms get worse, you may need surgery to replace the faulty valve with a new artificial one. Surgical options include traditional open-heart surgery or a minimally invasive procedure, such as a transcatheter aortic valve replacement (TAVR).
Before you undergo a heart operation, your doctor will do a few tests to assess your overall health and determine which treatment option is best for you. Your cardiologist and surgeon will work together to help you make an informed decision about your aortic valve repair or replacement.
Your health care team will perform a pre-operative assessment to ensure that you are healthy enough for surgery and that you can handle the anaesthetic and recovery process. This assessment will include a detailed history, physical exam and any specialized tests your doctor may request.
Your doctor will also talk with you about possible options for your procedure, including minimally invasive surgery and surgery using mechanical valves. These valves are non-reactive and tolerated well by the body.
The aortic valve is made of two leaflets that open and close to let blood into and out of the heart. Regurgitation (a leaky aortic valve) can occur for many reasons, including floppy leaflets, congenital abnormalities, infection or rheumatic disease.
Aortic valve replacement involves removing your damaged aortic valve and replacing it with a new one. This can be done through traditional open-heart surgery or by using a less invasive method called transcatheter aortic valve replacement (TAVR). The latter is more common and involves a catheter that is inserted into the leg or chest to deliver the new valve.
Aortic valves are important for keeping blood flowing through the heart and arteries. When they become diseased, they can reduce or block blood flow – called aortic valve stenosis or aortic valve regurgitation.
A surgical procedure to repair or replace aortic valves is typically performed using open-heart surgery, which involves making a large incision in the chest bone (sternotomy). Some procedures use minimally invasive techniques that involve smaller incisions and a shorter hospital stay.
One of these methods is called transcatheter aortic valve replacement (TAVR), which uses a catheter to insert a new valve into the aorta, without opening the chest bone. TAVR may be a good option for younger patients who have severe aortic stenosis, or those who can’t undergo traditional open-heart surgery because of their age or health.
Another method for repairing aortic valves is a procedure called balloon valvuloplasty. It involves inserting a thin tube (catheter) into the blood vessel, usually in the groin, and threading it to the heart. The catheter has a balloon on the tip that expands and widens a narrowed aortic valve.
Aortic valve replacement (AVR) is the most common form of heart surgery for aortic stenosis. It restores normal blood flow and improves function.
During aortic valve replacement, a doctor inserts a catheter through an incision in the groin and guides it into your affected valve. A new valve is then inserted and expanded to fully replace your damaged one.
The type of valve you get depends on what is best for your particular condition and health, says Marc Gerdisch, MD, medical director of cardiothoracic surgery at Franciscan Health Indianapolis. He recommends talking to your doctor about which valve is best for you.
The decision about which type of valve to use should be made after consulting your surgeon and taking into account many factors, such as your overall health and how well you respond to medications. Mechanical valves have been around for a long time and are the most popular choice, but tissue valves have come on the scene in recent years. Tissue valves don’t require the powerful blood thinners used for mechanical valves, so they may be more appealing to certain patients.